keywords
trauma, PTSD, psychopathology, resilience, mental health, risk factors, recovery, social support, cognitive reappraisal, emotional processing
- Psychopathology refers to less functional mental states, not just severe disorders.
- Gender differences in PTSD prevalence highlight societal vulnerabilities.
- Education and IQ correlate with lower PTSD risk, indicating the role of cognitive processing.
- Social support is crucial for resilience and recovery from trauma.
- Cognitive flexibility aids in reappraising traumatic experiences for better outcomes.
- Physical activity is inversely related to PTSD and stress levels.
- Altruism and purpose contribute to resilience in the face of trauma.
- Prior trauma exposure increases the risk of developing PTSD after subsequent traumas.
- Familial psychiatric history can influence an individual's risk for PTSD.
- Understanding the interplay of pre, peri, and post-trauma factors is essential for healing.
summary
This conversation delves into the complexities of trauma and its impact on mental health, particularly focusing on PTSD. It explores various risk factors associated with the development of PTSD, including pre-trauma, peritraumatic, and post-traumatic influences. The discussion emphasizes the importance of understanding these factors to foster resilience and recovery, highlighting the roles of social support, cognitive flexibility, and physical activity in mitigating the effects of trauma. Ultimately, it encourages a compassionate approach to healing and self-care.
transcript
Alright, ya’ll. While this feels a bit like beating a dead horse… we’re whippin again.
We were supposed to be done with this series. Hitting real world, accessible, micro behaviors that can help with the peri and post-trauma time period. Then tumbling into talking about relational varieties of trauma once more.
And instead of that work being released this morning…. hey, look what paper showed up after I requested it from my institution several weeks ago Risk Factors for the Development of Psychopathology Following Trauma. It’s the review article that seemed most relevant when I started this series, in the strange void of quality research on this topic. Now it has arrived.
COULD it have come sooner and saved the effort of discussing like 5 other papers to get to this point? SURE.
Also, huzzah for more information, because it’s revealing what really matters in PTSD prevention, as far as I’m concerned. Not necessarily through what they tell us, but through thinking about what they tell us, when it’s taken all together.
So. Today. Let’s talk about pre-traumatic, peri-traumatic, and post-traumatic risk and resilience factors for developing PTSD. Concisely.
And if you want more details… I’ll also be releasing a longer version with longer discussions of each point.
Then we will FINALLY wrap on this series that no one asked for. Just like trauma.
Before we start, thrice points.
- Psychopathology doesn’t mean “psycho” “pathology.” It means “unsafe or disruptive or less-functional conditions of the mental state.”
- Doesn’t all this “regular PTSD” reporting sound a lot like… complex PTSD. Relational PTSD. It does! Don’t worry, we’re going to talk about the crossover next. And lastly,
- I hope that during this cut and dry PTSD discussion you’ve been running through your own recovery efforts from various traumas and abuses. Perhaps, seeing why some trauma rebounds have been smoother than others. Maybe taking notes of what went wrong or right, to help yourself help yourself, more compassionately once some of that judgment might be able to be released. It’s not your fault if you’ve previously made moves that are now reported as “more likey to produce PTSD”… because good deal of this info runs counter to cultural “wisdom” about what to do. (Keep going, drink the pain away, don’t revisit the negative events!) Now we know better, so we direct ourselves towards less PTSD disturbances. And spread the word!
SO. Here it finally is…
Risk Factors for the Development of Psychopathology Following Trauma
Sayed, Iacoviello & Charney
2015
And let’s get to the bottom of this series, integrating everything we know.
They tell us:
Although, a staggering 89.7 % [11] of Americans are exposed to a significant traumatic event over the course of their lifetime, the majority of trauma-exposed individuals do not develop psychiatric disorders. PTSD is not an inevitable result of trauma exposure, as a relatively small percentage of those exposed to trauma develop PTSD whereas many others do not.
As PTSD is often considered the most severe manifestation of post-trauma psychopathology, this review will focus more specifically on the risk factors for developing PTSD and associated psychopathology in response to trauma exposure.
Pre-traumatic Factors
(AKA life conditions that make us more vulnerable, so trauma is more impactful when it hits)
Gender
Females develop PTSD about twice as often as males [19–21] The lifetime prevalence rate of PTSD for women is 8.5 and 3.4 % for men [22].
Let’s pause to say, “reported prevalence rate.” Which corresponds with “seeking mental and emotional help.” Which is going to be a point of difference between the sexes.
Generally, males report more traumatic exposures but females are exposed to more sexual trauma and are more likely to develop PTSD.
Let’s stop there, again, and say… reporting surviving a big T trauma like war or natural disaster is going to be socially easier, more connective, and more positively ego-ed… generally speaking… than reporting a sexual trauma. Without that social support and processing ability? You’ll be more likely to get PTSD.
Women with PTSD also experience symptoms longer than men [25] and are more likely to report poorer quality of life [26].
If life changes drastically after the trauma in a negative downturn, then the cognitive and emotional trauma aftermath becomes more dire. Because mentally, the experience is extended and it’s also deepened to have a greater, more destructive, meaning.
So women exposed are to more sexual trauma, which is poorly discussed, impossible to environmentally “clear away” since it’s attached to the body, and often linked with shame-blame-guilt…. (All of which is so pervasive, it’s hard to consider being a women ISN’T a covert trauma, all its own. Then the sexual trauma comes in and we’re told “you ARE DISGUSTING. Just look. But don’t talk about it.” )
AND, in reporting a lower quality of life, it’s not difficult to see how the mind can connect the sexual trauma and shame of being a women as a causation for that poorer life quality. Thus, creating a negative narrative which can increase PTSD symptoms.
Stereotypically speaking, men can be celebrated for their big-bad trauma survival. Women are often… not so much.
And also, I maintain that women are more likely to face negative twists and ramifications by being social underdogs. Which, I believe, we realize, before the trauma happens. So that pre-trauma, they’re already chronically stressed with awareness of a somewhat precarious position in society.
They continue:
In a recent quasi-prospective study assessing PTSD in Danish bank employees exposed to bank robbery, the authors found that females reported more PTSD symptoms than males [27]. The researchers contribute a combination of pre-, peri-, and posttruamtic risk factors such as neuroticism, depression, physical anxiety sensitivity, peritraumatic fear, horror, and helplessness, panic, dissociation, tonic immobility, posttraumatic cognitions about self and the world, and feeling let down, together, accounted for 83 % of the effect of sex on PTSD severity.
So women are more prone, supposedly, to all manner of stress responses. I think many of those things exist commonly because of the inherent danger and dismissal of being a woman in our social constructs. Women are told they’re weaker, less capable, more at risk, and likely to receive damage – not accolades – in traumatic situations. SO when a violent one presents itself? They’re physically and mentally fearful, as a normal biological response…. AND THEN ALSO reminded of exactly how relatively powerless they are, socially.
Posttraumatic cognitions about self and the world is a risk factor, they say? I think they’re describing what is often nothing more than the knowledge and actuality of societal and gender-based vulnerability in the female sex.
Age
The highest lifetime prevalence of PTSD was in a group of 45–59 years old (9.2 %) and the lowest prevalence (2.5 %) was in the group over 60 years old [28].
This finding doesn’t tell us jack shit without monitoring the same individuals over time.
At an advanced age is trauma just another “drop in the bucket” of experience? So there’s less of a reaction to it?
OR. Are they saying that as we get older, we stop recalling our traumas?
OR. Are they saying that generationally, boomers are less likely to report having PTSD?
Can’t tell. The citation doesn’t help clarify anything. It certainly doesn’t discuss differences between the age groups in the acceptability of mental disordering or probability of reporting such things.
(fart noise) this is not a helpful – or probably “real” - finding. And I’ll leave it there.
Onto a point that we briefly touched on last time, but with a more helpful expansion on that information:
Education/IQ
Education is strongly correlated with IQ, and IQ has been shown to be inversely correlated with the risk of PTSD and other psychiatric disorders [32]. Breslau and colleagues reported that children who had an IQ greater than 115 at 6 years old had a decreased risk of PTSD after a trauma exposure [33]. Consistent with these results, it has also been reported that IQ assessed at age 5 was inversely associated with the risk of developing PTSD at age 32 [34]. In a 17-year prospective study, researchers concluded that overall, high IQ protected trauma-exposed individuals from developing PTSD.
Well, this is better information than “educated men are protected.” Because hasn’t education and ability for cognitive reappraisal significantly affected your PTSD? If we’re able to think about things from multiple perspectives through integrating new information, we’re more likely to resolve PTSD, than getting stuck in one rigid story of doom.
And also, I’ve gotta report… intellect allows people to analytically disregard their PTSD in a lot of ways. Ohhh the number of fuckers who can REPORT on their progress, without actually making progress... it’s significant. So high IQ is perhaps not necessarily protecting people from PTSD… but protecting them from being obviously impacted by it or displaying the symptoms of it.
Lastly, again, though, beyond both those considerations and at the core of the conversation…
IQ is often tethered to societal privilege. Better nutrition? Better caregiving and education experiences available to you? You’re more likely to be hitting or surpassing developmental milestones and building a stronger cognitive capacity. So, IQ is probably indicative of many life factors that can prevent or prime us for PTSD, such as resources, opportunities, and social support. These things are also being measured. Not just intelligence.
Just like this next point:
Race and Ethnicity
Researchers found that the lifetime prevalence of PTSD was highest among Blacks (8.7 %), intermediate among Hispanics and Whites (7.0 and 7.4 %), and lowest among Asians (4.0 %) [35]. These results are consistent with previous studies reporting whites have higher risks of exposure to any traumatic event [37, 38]. Although Whites were more likely than the other groups to have any trauma, among those (who were) exposed to trauma, PTSD risk was slightly higher among Blacks and lower among Asians compared with Whites [36].
Once more! PTSD is highest among those who have had, historically and generally still to this day, the worst time in society. Please refer to everything already stated about women.
I’ll maintain, (at least in this country) any minority group is probably at a higher risk of PTSD due to their awareness of social vulnerability AND the unfortunate reality of that knowledge. Physically, they’re more in-threat. Mentally, there is additional stress from this knowledge. Refer, here, to the prevalence of “the talk” in American black culture.
As far as whites reporting the most TRAUMAs? Well, it’s based on REPORTING. Whites may interpret more events as traumatic, may have more resources to seek treatment, as well as more cultural acceptance of mental health matters… thus appearing to make a larger impact on those stats.
And, lastly, not to generalize too much about a race that I’m not a part of, but considering the cultural focus on honor, strength, and achievement… doesn’t it make sense that Asian populations might report less PTSD than everyone else?
I worked in biomedical research academia. Uh… the things I saw many Asian peers putting themselves through was, to me, traumatic. Abusive. Self-abandoning. To them? Just doing what they were supposed to do. If their narrative isn’t negative, will they develop PTSD? It’s less likely.
Sexual Orientation
Several studies have found elevated prevalence of both childhood maltreatment and adulthood PTSD in sexual orientation minorities [42, 43]. Lesbians, gay males, and bisexuals, referred to as sexual minorities, experience higher rates of early childhood abuse and greater exposure to violence and traumatic events [40]. Sexual minorities have been reported to have a 1.6 to 3.9 times higher risk of PTSD compared to a heterosexual reference group [41].
Okay, this report is stating – similar to women – that there are more childhood abuse events for sexual minorities. And THAT could be the cause of the increased chance of PTSD.
And. On top of the point-blank early exposure to abuse, which we’ll find out soon, is a risk factor for LATER PTSD… this is another at-risk group in global society. They’re aware of it. They’ve already experienced it – personally or through observation - by the time adolescence hits.
And, thus, they recognize that it takes a far weaker breeze to blow their lives to dust, as compared to hetero counterparts. See: the crossover between homosexuality and houselessness. Especially in teens and young adults. Taking a tumble often puts them in additionally compromised positions; culminates in MORE risk factors and perhaps poorer life outcomes.
Which, again, extends the story of the trauma and creates a sense of “having a target on one’s back.” Forever. For their very identity. Yeah, that’s some PTSD material. It’s stressful to feel “unallowed to exist.”
Pretrauma Psychopathology
The psychopathology of an individual prior to the trauma has also been implicated as a risk for developing PTSD. Children rated as having externalizing problems above the normal range at age 6 were more likely to develop PTSD than children who were rated as normal externalizers [33]. Likewise, children who were categorized as highly anxious or having depressive mood in first grade were also at higher risk of PTSD at age 15 when exposed to traumatic events compared to their peers who did not have these psychological symptoms [44]. Children with difficult temperaments, fewer friends, or antisocial behaviors were more likely to develop PTSD than their peers who did not have these characteristics [34].
Okay, first of all. Externalizing problems are behavioral issues characterized by acting out on the external environment, i.e. aggression, impulsivity, and rule-breaking, hyperactivity, bullying, and conduct problems. They are a distinct category from internalizing problems, which involve inward-focused issues like anxiety and depression.
And the authors ALSO said that children with anxiety and depression were at an elevated risk factor, too.
Children who aren’t thriving… are often in some way in a state of “surviving”… which we know, can mean that every second of life is stressful, threatening, risky.
THEN a trauma enters the picture? Sure, crank that stress level up to 20 as the child takes it as a personal punishment or indication of wrongness… which, left untreated, isn’t going anywhere for the next 80 years. That’s lifelong CPTSD! How many of us got here!
And if we’re baseline equipped with anxiety or depression, of course, another layer of it imparted from a traumatic event is going to be more serious than if starting from 0. Contributing to increased stress and depressive events, compared to the norm.
Lastly, they said: Children with difficult temperaments, fewer friends, or antisocial behaviors were more likely to develop PTSD than their peers who did not have these characteristics. To me, this is suggesting the same thing again. A lack of social support is available pre-, peri-, and post-trauma… probably starting in the family and cascading into their peer connections… which is another inherent, ongoing, threat to the brain. Being social isolated. It’s also a hindrance to processing the trauma or safely emoting about it.
Similarly:
Prior Trauma Exposure
It is now well known that exposure to prior trauma has been implicated in PTSD. Pretrauma psychopathology increases the risk of PTSD. Additionally, childhood abuse is a risk factor for PTSD. Women who experienced physical abuse during childhood had a higher risk of lifetime PTSD [45]. Additionally, people who experienced a traumatic event before the target stressor reported higher levels of PTSD symptoms than those who did not, especially among individuals who experienced noncombat interpersonal violence [45]. However, more recent studies have shown that it is not the prior trauma experience, but the development of PTSD symptoms in response to a prior trauma that increased the risk of PTSD after a later trauma [46, 47].
So PTSD breeds more PTSD.
Of course. If you have PTSD once, your brain is potentiated with thoughts, emotional pathways, and biological factors to have it again.
AND, in a cognitive way, the second (or beyond) incidence of experiencing an impactful trauma will tell the brain “see, look how dangerous life is. We knew it, all along. This can keep happening and there’s no reason to believe it won’t, based on this repeated evidence.”
When trauma seems to follow you everywhere you go, it’s easy to feel targeted by the world, by the universe, by the human population. If you believe you can’t walk outside without being struck by lightening… AND gather evidence that confirms it a few times over… yeah, it’s a stressful condition to exist in, which will exponentially increase the impact of ANY negative event by confirming what the mind already suspects about its vulnerable position of self vs. the world.
This next point probably adds to that strain:
Familial Psychiatric History
Individual studies have shown that parental mental health disorders are associated with increased risk of PTSD, even after controlling previous traumatic events [48]. Maternal depression has also been shown to be associated with increased risk of PTSD [34]. Statistically significant associations between PTSD and family psychiatric history of depression, anxiety, and psychosis have also been reported [49]. In addition, recent genetic studies showed that relatives of PTSD patients had higher risk of the disorder than relatives of similarly trauma-exposed controls who did not develop PTSD [29].
This one wraps up everything we’ve already discussed… and then made it a multigenerational issue. If one person realizes they’re at risk for various reasons (gender, race, societal position)…. And then passes that on to another individual who shares the traits… priming them with stress… who then has their own experiences realizing the same… the story is proven true! The stress is demonstrably correct! The fear of life is established AND verified.
This is how PTSD can be transferred from one generation to another, not only through modelling and protective storytelling, but also in creating similar experiences and mindsets.
AND there’s probably a lack of measured, rebalancing, emotionally-significant, cognitively-reappraising social support on the other side of trauma, in these circumstances, as well.
you experience a trauma and your mom says “I told you the sky was falling all these years, glad you’ve caught on”… or provides a shaming environment due to their own psychopathology… or otherwise isn’t available to be supportive for the same reasons… well… that factor is going to move the needle in the wrong direction. Hurting, not helping with healing.
AND if we know that our families are a bit… off… we’re also put in a risky headspace pre-trauma of recognizing that we don’t have the support we need normally, let alone in a dire time. So, once more, individuals are stressed, to begin with. Then the traumatic event is just the cherry on top to create disorder.
Neurobiological Factors
Studies have also identified neurobiological factors that appear to influence resilience, including genetic factors and neurochemical systems involved in the stress response and the function of specific neural networks [51, 52].
Recently, a study was conducted using data from a large longitudinal study of 340 healthy young adult researchers and demonstrated that individual differences in threat-related amygdala reactivity predicts psychological vulnerability to life stress occurring 1–4 years later [53]. The results of this study are consistent with previous studies that identify risk factors for depression and anxiety disorders in relation to increased amygdala reactivity to threat [54–56].
Additionally, twin studies of male Vietnam veterans established a genetic influence of about 30 % for the vulnerability of PTSD.
Researchers have identified genetic markers linked to PTSD by analyzing blood samples from 188 U.S. Marines taken before and after deployment into conflict areas. U.S. Marines who developed PTSD symptoms were compared to those who did not. They identified modules of co-regulated genes involved in innate immune function and interferon signaling [60]. These results were replicated in an independent smaller sample of 96 Marines.
Twin and family studies also provided evidence that most genes that affect the risk of PTSD also influence the risk of other psychiatric disorders, including major depression, generalized anxiety disorder, and substance abuse [59].
Indeed. We know that there’s a genetic component of PTSD. Our genes become methylated for different degrees of expression thanks to our family’s trauma. You know it by now, fear of specific scents can be passed on genetically in rat samples in this manner.
And also…. we don’t know how much the environment is influencing expression of these markers. Even twins can have entirely different experiences and resulting perceptions, which are impossible to separate from their role in PTSD development. Or, they can have THE SAME STRESSED OUT PARENTS, race, gender, sexual experience, education, and established psychopathology… and those stresses can pile up organically. Socially.
And to their point: Twin and family studies also provided evidence that most genes that affect the risk of PTSD also influence the risk of other psychiatric disorders, including major depression, generalized anxiety disorder, and substance abuse [59]…. Cool. I would argue that PTSD commonly includes all of these things. So, they may have measured prevalence of transmission of intergenerational PTSD, not interrelatedness of separate mental disorders.
AND SO CONCLUDES THE INFLUENTIAL PRETRAUMATIC FACTORS.
Gender, race, age, education and IQ, sexual orientation, Pretrauma Psychopathology, Prior Trauma Exposure, Familial Psychiatric History, Neurobiological Factors… these are the background conditions that seem to increase or decrease later risk of PTSD based on correlation.
It’s important to note time and time again that causation is unclear. And often the data, to me, is not what I would consider “clean.” Or “without socio-psychological explanation.”
Again and again, we heard about things we have no control over, which influence mentality, mindset, and baseline stress level… just as much as they could directly affect us during traumas.
And that psychological aspect of known social (and therefore, life) vulnerability might be the real threat.
Now, onto peritraumatic factors. DURING the trauma, what seems to draw the line between psychopathology and returning to healthy homeostasis? Well, they come right out the gate, reiterating what I’ve been screaming so far today:
Peritraumatic Factors
Trauma Type and Severity
Trauma type and severity are important in determining the risk of developing PTSD, whereas the highest PTSD risk is associated with physical injury or sexual assault [29]. (however) Peritraumatic factors can include the perception of the trauma and how it is experienced by the individual on a cognitive level, as well as on a biological level in terms of the body’s stress response [13, 15]. The perception of the trauma as a true threat to one’s life and that one has suffered major losses as a result are also associated with greater risk [45, 61].
That’s the ticket. You can lose it all and be fine… if you’re also pretty certain that you’ll regain it all. You can lose very little and suffer devasting PTSD… if you’re convinced that what you lost was the achilles heel to your life.
Which can shine a light on why the variety of trauma matters so heavily.
Physical injury, point blank, is more likely to impact the rest of your life. Feeling like it is a “major loss” is likely. And similar with sexual trauma. In both cases the relationship between you and your body is damaged. Your sense of autonomy, effectiveness, and acceptability are affected. It lasts, perhaps, the rest of your life.
You can get a new home, you can’t get a new meat suit or necessarily a new, trusting, perception OF that meat suit.
Not to bring this back to me again. However, can attest that health and sexual trauma have been some of the most long-lasting and debilitating sources of ongoing stress, compared to the rest. If you lose faith in your system, you lose faith in your ability to navigate life safely.
Overall point being… trauma is PERCEPTUAL. Not definite. There is no way to compare trauma between individuals or their relative PTSD outcomes.
Which corresponds nicely with our next and last Peritraumatic point.
Continued Perception of Threat
And I’ll say, these authors jump into this blurb a bit strangely, in my opinion. It sounds like I’ve cut out some words and I have not. However, they bring back a point we quickly skimmed over last time. Debriefing. Does it end the perception of threat?
They say:
The ineffectiveness and occasional harmfulness of debriefing as an immediate intervention after disaster or trauma highlight the importance of Bending^ the perception of threat or trauma as soon as possible to maximize the likelihood of adaptive outcomes. The main idea behind debriefing was to promote emotional processing by encouraging recollection of the event, versus promoting avoidance and maladaptive emotional outcomes. Debriefing has origins with the military, where sessions were intended to boost morale and reduce distress after a mission. Debriefing was done in a single, mandatory session with seven stages: introduction, facts, thoughts and impressions, emotional reactions, normalization, planning for future, and disengagement [62, 63].
Ahhh, sounds nice. Look at the military, protecting its heroes. They continue, without skipping a beat:
There are several theories as to why debriefing increased incidents of PTSD.
First, those who were likely to develop PTSD were not helped by a single session. Second, being re-exposed too soon to the trauma could lead to retraumatization. Whereas exposure therapy and cognitive behavioral therapy (CBT) allow the person to adjust to the stimuli before slowly increasing severity, debriefing did not allow for this.
This suggests that the ability to disengage from the traumatic experience and perceive it as over, may be an important factor influencing adaptive responses to trauma versus the development of PTSD.
Let me again provide a short story. My father was in a work accident in his late 30s that disfigured his body. From that event, he became addicted to opiates. From that addiction, he lost his marriage, career, home, steady income, relationships with his friends and family members, and one of his children (me, age 11). SO. Do you think the trauma “ended” after that piece of metal crushed his foot and all the resulting surgeries? Or do you think the trauma became one long, ongoing, condition of being alive? And which one do you think would be easier to recover from?
If the event ends and “life moves on normally,” that’s less likely to create PTSD.
If the event happens… and then continues to knock over dominoes leading straight off the edge of the table… it’s like POST traumatic events never happen. ALL experiences become peritraumas, in one long string. So stress never subsides. Let alone processing beginning.
And, apparently, debriefing is not the solution to this problem. It does NOT assure anyone that “the bad time is over, you’re safe now.” Probably because they can’t control what happens after the debriefing, just as much as the debriefing, itself, was potentially retraumatizing and too-soon to be enlightening.
Tell them what happened and give them a sense of normality – great! And then soldiers walk out of that meeting and still have innumerable unknown threats to deal with, which aren’t being discussed as separate events or psychologically treated.
From this point we can take away… that it doesn’t help us to do an information dive during or right after we experience a trauma. That won’t save our psyche. It might only agitate things further, especially if we aren’t protected from further stress afterwards.
That’s it for this paper on peritraumatic influences. Severity of the trauma and continued perception of threat are, according to these guys, the peritraumatic factors that make or don’t make post traumatic disordering.
Questionable? Yes.
But we’re dumped here at Posttraumatic Factors, as they tell us about:
Posttraumatic Factors
Access to Needed Resources
Psychological first aid (PFA) [64] is an evidence-informed modular approach for assisting people in the immediate aftermath of disaster and trauma to reduce initial distress and to foster short and long-term adaptive functioning. It is based on the idea of addressing pragmatic needs: what does the individual need immediately after the trauma, how can their experience be normalized instead of pathologized, and how can they be encouraged to cope effectively?
Critical components of PFA include protecting the individual from further harm and providing the perception that the trauma is over. This includes connecting individuals with required services (social services, emergency housing, food, clean clothes, etc.). The opportunity to talk without pressure and the presence of active listening, compassion and addressing and acknowledging concerns contributes to a sense of social support. During PFA, discussion will often include normalizing the individual’s emotional responses to the trauma, discussing possible coping strategies and relevant referrals.
Ah! Sounds great, right? Then they say:
It is important to note that despite some smaller preliminary reports, evidence for the efficacy of PFA is currently lacking [65].
Okay, maybe not that great.
Again, this sounds like debriefing to me. You can inform the individual immediately posttraumatically and try to force psychological welfare up their brain stem… and this doesn’t mean you’re saving them from PTSD.
Perhaps because people need to process when they’re ready.
Perhaps because you can’t control what, then, happens AFTER the PFA is administered. A subsequent negative event might cause them to reject the care that was previously provided and revert to an even MORE stressed out condition.
And.
Perhaps PFA isn’t very effective because the individual is aware that this is a PROGRAM, and that doesn’t necessarily empower them to feel less at-risk or more-powerful in their own right, in their own life, int their own skin.
Long-term, maybe they don’t feel more protected or confident. Maybe they feel more like charity cases who happened to be assisted. Maybe this actually feels LESS comforting, or contributes to feelings of victimhood being recognized by others. Which is actually a social risk. We don’t want to appear vulnerable to the herd. PFA may be suggesting exactly that.
This is all very different from actual, person to person, not-a-government-mandate, connection-based:
Social Support
Data suggest considerable emotional strength comes from maintaining a social support network. Lack of social support by a spouse, friends, and family after a traumatic event and ongoing life stress also increases the risk of developing PTSD [45, 50]. In recent studies of PTSD in veterans, PTSD was greatly associated with less social support, difficulties in relationships and poor social functioning [66].
Little to no comment here. We know, social support makes life less stressful.
AND. Social support is inextricable from many of the pre and peri trauma factors we’ve already discussed. Time and time again, those aspects are correlated with or indicative of a limited or lacking or less influential social support sphere.
As social animals, if you’re not estimating yourself to be “on your own out there,” your brain and body are going to be less stressed. Connective relationships lead, in general to more positive life outcomes, across age groups. And. We know that supportive relationship enables emotional and cognitive processing. Perspective support, compassion, and event defragging can all come through organic, individual, relationships.
Leading us to:
Post-Trauma Cognition
AKA cognitive reappraisal
Cognitive flexibility refers to a person’s ability to reappraise the perception and experience of the traumatic experience instead of being rigid in one’s perception. Being rigid in one’s perception makes acceptance and recovery increasingly difficult. Traumatic experiences can be reevaluated, adjusting the perception and meaningfulness of the event.
For example a person who encounters a traumatic event involving an assault by a man can hold on to the belief that all men are dangerous. This type of inflexibility leads to the development of several PTSD symptoms such as hyperarousal, hypervigilance, and avoidance. Being open to the idea of acceptance and assimilation of the traumatic event into one’s life narrative can lead to recovery [68].
Implications for psychosocial interventions to promote resilience after trauma include cognitive processing therapy (CPT) [69] and prolonged exposure therapy [70] both geared towards modifying cognitions associated with the trauma and enhancing cognitive flexibility as a means of initiating symptom reduction (e.g., reducing avoidance after modifying the core beliefs associated with the trauma).
Research studies have demonstrated optimism as being associated with psychosocial well-being in a non-PTSD trial of breast cancer survivors [72] and with lower posttraumatic symptoms after experiencing a deadly earthquake [73]. Together, optimism and cognitive flexibility provide an individual with faith that they can eventually prevail and survive [74].
Ah, so we finally hear how CBT is connected to trauma resilience after it was so briefly thrown at us in the Intro to this series. Because it contributes to changing our reactions and perspectives. We don’t want to be stuck in our stories or resulting behaviors, which are likely to be rather cataclysmic and extreme during or immediately after the event. Those narratives make or break us… so we comparatively prosper when we can steer them towards functional and flexible stories that enable us to keep living.
If your story ends in willful empowerment and a sense of maintained control… stress is reduced… and PTSD may be staved away.
Which isn’t necessarily something we can force unto ourselves. However, we can take Wegner’s ironic mental control processes into the discussion and say “focusing on trying to rid ourselves of the negative, pessimistic views and mental health outcomes… is going to increase their prevalence and impact.” Don’t focus on signs of pessimism or depression or fear, or you’ll bring them into reality, more strongly. Focus on creating perspectives that HELP you. And then test those perspectives in reality, over long periods of time, to show yourself they’re real.
And as far as other things we actually can control? It’s back again.
Physical Activity
In contrast to a physically inactive lifestyle, being active is inversely related to stress, physical health problems, and the development of chronic diseases such as PTSD, depression, and substance abuse [76, 77].
Indeed. And again we can say… that relationship between self and the body? Makes a big difference. Even after a social trauma, feeling you can rely on your biology is going to be a protective experience, versus being incapacitated or needy. And on top of that… yeah, biologically, our nervous systems are calmed and nourished by being used for what they exist for. Moving. Working. Functioning, together, as complex systems.
So, when in doubt… when there’s nothing else we feel like we CAN do? We can care for ourselves, in whatever ways are accessible to us. Even if that’s just going for more short walks or stints sitting outside, breathing, stretching, lifting a heavy thing. We can help ourselves by remembering our bodies are here, they’re the conduit between mental and worldly activities, and working with them as such.
Just like we can always work towards… our final point:
Embracing a Moral Compass
Altruism has been strongly associated with resilience in children and adults [81, 82]. Altruistic behavior can contribute to purpose in life.
The hopelessness theory of depression has shown that hopelessness and depression can stem from maintaining negative beliefs regarding the stability, globality, and internality of the negative life event that occurred [83].
Conversely, maintaining positive core beliefs may prevent the development of hopelessness by helping the individual adopt a more adaptive way of thinking when faced with traumatic events. (AKA the cognitive reappraisal we just discussed)
While more empirical study of these ideas is needed in traumatized samples, a study of Pakistani earthquake survivors’ found that their purpose in life was associated with lower PTSD and depressive symptoms [84].
So, as we’ve discussed last time… make positive meaning from the events AND maintain a life structure… not by focusing on a job or career, which are both unpredictable, relatively unstable, and not necessarily “for anyone’s best good” or “in line with your core values”…. But by consistently engaging in something that feels purposeful to you.
Maybe life has changed. But if that life has changed so that you’re working on something that emotionally satiates you… that speaks to your soul-Self-thing… then suddenly the event is less of a tragedy and more of a pivotal moment in time.
Remembering what matters to you and reorienting towards that thing? That’s a PTSD protective factor that spans social support, optimism, even physical welfare. And can include spiritual healing – lifestyle rehabilitation, emotional healing, and psychological recovery – with a side of “was this all MEANT TO HAPPEN?” - to boot.
Making a positive out of a negative. Bringing the individual into greater alignment with them self. And maybe even reducing overall stress by reminding them of all the ultimately unimportant things they were focusing on before the trauma took place – so they can be let go of.
A newly tuned moral compass? Means a more fulfilling direction for the rest of life. Which is going to create more functional, empowered, clarified perspectives. And increase… you guessed it… PTSD resilience.
As much as it makes CPTSDrs cringe, and I understand why. It helps the individual’s mindset when there’s estimated to be “a good reason bad happened.”
And that, fuckers, is the rundown from this article. Which was very concise. Until I added all my own thoughts and questions.
What did we learn? There are many factors we’re not in control of which predispose us to the threat of developing PTSD.
That’s a reality many of us know all too well.
Race, gender, sexual orientation, history of psychopathology, history of PTSD, and allllll things family – such as THEIR psychiatric disordering and neurobiological contributions contained in our DNA… In this paper, they DIDN’T discuss low socioeconomic status as a risk factor, but we can read between the lines about how it tends to fit in with many of these other points… And yes, it’s true, we’re not able to simply fix those lottery results. Or the society that makes them stress factors.
AND ALSO.
There are risks and protective factors we can influence. Such as purposefully engaging in cognitive reappraisal, exercising our meat robots, maintaining connections that help create a self-allowing environment, limiting disassociative hobbies, looking for “end points” between traumatic events, and avoiding avoidance (masquerading as coping) through exposure therapy, cognitive processing therapy, and narrative formation. They sound like limited points of self-assistance, but taken together, these add up.
AND on top of all that (actually kindof good news)…
Knowledge that we’re in those aforementioned risky groups we can’t control, themselves, can be a protective or rehabilitation-allowing factor, itself. Education and prompts for cognitive work. If we recognize that our mindsets and streaming thoughts in the trauma aftermath are built on the backs of these psychically threatening conditions… we can get a more comprehensive picture of the stress we’re experiencing – perhaps, a great deal of it subconsciously and automatically – and work to treat ourselves with more gentle care in light of all those relevant, logical, anxieties – increasing self-compassion - while also doing the processing work to untangle the new trauma from past and premonitory stresses that are layered within…. We can effectively stay with ourselves. See ourselves accurately. And tend to those little beans to the extent they require.
Why is a fire event not JUST a fire event?
Because I’m a woman with no right-minded family to lean on, a history of psychiatric disorder, including PTSD, and limited resources. These stress points create a much larger story of danger. Active the nervous system to a, perhaps, greater and more severe degree.
And I’m willing to bet that any traumatic event you’ve experienced has been similarly stacked with extra opportunities for mental, emotional, and physical stress. Ones that are easy to miss or exclude from consciousness in appraising what has happened. An abusive relationship isn’t JUST an abusive relationship. A horrible workplace, same.
With that realization of the allostatic load we’re ALWAYS working with… we can reparent ourselves more kindly than the first (and let’s be honest, twentieth) time. We can tend to our physical bodies, emotional experiences, and narratives with more guidance, space, and care than the early events that gave us PTSD.
And avoid another round of it. Through recognizing our power, our control, our educations and IQs, to make an impact on our own experience… now, and for years into the future.
Without needing even ONE MORE PAPER to tell us that it’s possible. And we’re not only is it allowed… but it is accountable – to ourselves and the people we love… to do the hard work of post-traumatic processing, meaning finding, and self-care. With compassion.
Compassion you may not have been issuing to yourself this whole time, peri-trauma or not.
It’s impossible to predict how anyone will be affected by anything, because most of the pre-trauma, peri-trauma, and post-traumatic considerations we’ve discussed here are impossible to separate. Even BEFORE a trauma, we can anticipate what a trauma will be like for us, in our personal life-circumstances, versus our innate societal and material challenges. And we can anticipate how our lives will rebound or ail in the aftermath.
That’s a baseline stress load that we all carry.
Trauma is PERCEPTUAL. It's all about where you come from and where you estimate you’re going. It’s about the stories we can and can’t tell ourselves. All of these discussed factors over the past two episodes drastically affect the prior understandings and future outlooks of individuals.
Which are then elevating or stunting stress responses PRE-trauma, which will affect stress levels PERI-trauma, and also POST-trauma. Again. They can’t be separated.
Time is nonlinear. And so is the human capacity for looking ahead, deducing what’s likely, and becoming stressed or supported by those predilections.
What we come from matters.
And maybe more than that, how we view what we come from as it influences our ability to prosper in the future… matters.
….
And with that, have you listened to the Perspective series from 2022, in which we came to this same conclusion? PTSD is about the impact on our bodies, our brains, and therefore… our beings… through the storylines we find ourselves on…. not about measurable effects that protect or predispose an individual to PTSD… not about “traumatic variety, severity, or load” as measured in a laboratory.
So, from all of this, I have to say…. As much as possible… write the best story you can.
And pass it on.
With progeny and purpose.
Cheers Fuckers.